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• Intoxicated Motor Vehicle Passengers Warrant Screening and Treatment Similar to Intoxicated Drivers.

  Schermer CR, Apodaca TR, Albrecht RM, Lu SW, Damerest GB. J Trauma 2001; 51(5): 1083-1086.
  
  Correspondence: Carol R. Schermer, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM USA.

  BACKGROUND: Alcohol interventions decrease alcohol consumption and recurrent injury.
  
  OBJECTIVES: The study hypotheses are (1) intoxicated passengers are similar to intoxicated drivers in crashes and driving under the influence of alcohol (DUI), and (2) DUI conviction rates after injury are low.
  
  METHODS: Intoxicated motor vehicle occupants hospitalized for injury in 1996–1998 were matched to the state traffic database for crashes and DUI. Drivers and passengers were compared for crashes and DUI in the 2 years preceding and 1 year after admission. Driver DUI citation at the time of admission was also recorded. A logistic regression model for crash and DUI probability was constructed.
  
  RESULTS: Six hundred seventy-four patients met inclusion criteria. In the 2 years preceding admission, passengers and drivers were equally cited for crashes (14.7% vs 19.3%, p = 0.12). In 1 year after admission, they were also equally cited (7.1% vs 7.7%, p = 0.92). Driver/passenger status was not a predictor by logistic regression; 13.4% of intoxicated drivers were convicted of DUI for the admitting crash.
  
  CONCLUSIONS: Intoxicated passengers and drivers are equally likely to be cited for crashes and DUI before and after admission for injury. Few admitted intoxicated drivers are convicted of DUI. Screening and intervention for all intoxicated crash occupants is warranted.

The following abstracts concern comments upon the Guide to Community Preventive Services reports in a recent issue of the American Journal of Preventive Medicine:

• Note from the surgeon general

  Satcher D. Am J Prev Med 21(4, Suppl. 1): 1-2.

  At the intersection of public health and transportation safety is the concern for reducing injuries to motor vehicle occupants. Progress in motor vehicle injury prevention stands out as one of the ten significant public health achievements of the 20th Century. Although six times as many Americans drive today as did in 1925, covering ten times as many miles in eleven times as many vehicles, the annual death rate from motor vehicle crashes has decreased 90%. Yet approximately 40,000 Americans of all ages still die each year as a result of motor vehicle trauma. Motor vehicle crashes are not "accidents," and much can be done to prevent them and the injuries that result.
  
  Safety and injury prevention must be among our highest public health priorities as a nation. Our national commitment to reducing injuries and deaths from motor vehicle crashes, especially those involving alcohol-impaired driving and failure to use seat belts and child safety seats, are important objectives in Healthy People 2010, our nation's prevention agenda for the next 10 years. With these objectives in mind, the authors present the results of years of work in summarizing the scientific evidence and preparing a set of recommendations to further reduce injuries among motor vehicle occupants. The systematic reviews of evidence and recommendations appearing in this supplement to the American Journal of Preventive Medicine (AJPM) address interventions to increase child safety seat use, increase safety belt use, and reduce alcohol-impaired driving. The recommendations from the Task Force on Community Preventive Services (the Task Force) emphasize that no one strategy will address all the underlying causes of motor vehicle crashes and the resulting death and disability. Decision makers at the federal, state, and local levels should seek to implement a variety of strategies to reduce motor vehicle crashes and their often tragic consequences. (Dr. Satcher's complete commentary may be read free online HERE.)

• Public health's contribution to motor vehicle injury prevention.

  Waller PF. Am J Prev Med 21(4, Suppl. 1): 3-4.
  
  Correspondence: Patricia F. Waller, PhD, 1779 Crawford Dairy Road, Chapel Hill, NC 27516 USA, (E-mail: pwaller@umich.edu.)

  This supplement to the American Journal of Preventive Medicine addresses interventions that were considered impossible a quarter of a century ago. Drunk driving was considered more or less a "folk crime," almost a rite of passage for young males. Most adults in the United States used alcohol, and most of them, at some point, drove after doing so. This is not to say that they drove drunk, but many of them undoubtedly drove when they were somewhat impaired. Although the law provided for fairly harsh penalties, they were rarely applied. Upon arraignment, defendants would ask for a jury trial, and because drinking and driving was so widespread, juries almost invariably acquitted the defendant, thinking, "There but for the grace of God go I."
  
  Seat belt laws were rejected out of hand by legislators as well as many in the research community. Although other industrialized nations were enacting them, it was widely agreed in the United States that we would never tolerate such imposition on personal freedom.
  
  Today, we have laws and programs that have reduced drinking and driving, increased occupant restraint use, and had a major role in reducing motor vehicle injury and death. If we were still experiencing motor vehicle fatalities at the 1966 rate, based on vehicle miles driven, we would have had about 147,000 such deaths in 1999 rather than the 41,611 that actually occurred. The dramatic reductions in motor vehicle crash injury and death represent a major public health achievement. What has made the difference? (Dr. Waller's complete commentary may be read free online HERE.)

• The effectiveness review trials of Hercules and some economic estimates for the stables.

  Miller TR. Am J Prev Med 21(4, Suppl. 1): 9-12.
  
  Correspondence: Ted R. Miller, PhD, MS, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, #300, Calverton, MD 20705 USA, E-mail: miller@pire.org

  The literature on motor vehicle safety is vast. Consequently the review effort reported in this supplement was Herculean in scope and difficulty. It introduced me to many solid and important effectiveness studies. At the same time, it occasionally omitted effectiveness studies that I cite. Returning to my sources heightened my appreciation of the Task Force on Community Preventive Service's (the Task Force) trials. The first trial was finding the studies. Two examples are informative. A National Center for Health Statistics publication finds that 92% of low-income parents who own child safety seats use them routinely. That report, however, covers a wide range of parental safety practices. It lacks keywords and is not indexed. Again, an article in an economics journal uses confidential 1983 National Personal Transportation Survey microdata to analyze how people make decisions about using motor vehicle safety equipment. The paper includes a logit regression explaining child seat use. One explanator is residence in a state with a child safety seat use law (in force in 1983 in 15 states housing 38.5% of the 934 respondents with children under age 5). The model focuses on the influence of individual factors like parent age, income, and education on seat use decisions, but in the process it produces the best extant evaluation of the impact those laws had on seat use. It finds that laws increased seatbelt use by 42.3%, with 17.7% diverted from belts and 24.6% restrained for the first time. These findings, however, are by-products. They do not appear in the abstract and merit only one sentence in the text. To the author, a restraint law was just another regression coefficient. How could a systematic search find these studies? (Dr. Miller's complete commentary may be read free online HERE.)

• See report under Rural and Agricultural Issues

• Snowmobile injuries in Utah.

  Skokan EG, Olson LM, Cook LJ, Corneli HM. Acad Emerg Med 2001; 8(12):1173-1177.
  
  Correspondence: Elisabeth Guenther Skokan, Division of Pediatric Emergency Medicine, Primary Children's Medical Center, 100 North Medical Drive, Salt Lake City, UT 84113. (E-mail: eskokan@hsc.utah.edu.)

  OBJECTIVES: To describe the epidemiology of snowmobile injuries in Utah.
  
  METHODS: Analysis of probabilistically linked statewide emergency department (ED), hospital admission, and death certificate data for 1996 and 1997.
  
  RESULTS: There were 625 cases of snowmobile-related injuries. The majority (83%) were evaluated in the ED only. Median ED patient age was 29 years (range 3-74 years), and 66% were male. The leading diagnoses were open wounds to the head (7.8%), back strains (5.4%), and contusions of the trunk and lower extremities (5.2% and 5.0%, respectively). An Injury Severity Score (ISS) of >/=4 (range 1-75) was found in 37% of the ED patients. The median charge was $373 per patient, with two-year cumulative charges of $266,283. One hundred seven patients required inpatient hospital care. Median inpatient age was 32 years (range 4-92 years), and 60% were male. Leading inpatient diagnoses were fracture of the vertebral column (9.3%), lower extremity fracture (9.3%), upper extremity fracture (6.5%), and pelvis fracture (3.7%). An ISS of >/=4 (range 1-38) was found in 70% of the hospitalized patients. Average length of stay was 3 days, with a range of 1 to 68 days. Median inpatient charge was $6,003 per patient, with two-year cumulative charges of $1,333,218. Ten inpatients required transfer for rehabilitation or skilled nursing care. There were a total of six fatalities, three of which occurred in the ED, one in the inpatient population, and two identified from the death certificate database.
  
  CONCLUSIONS: By combining ED, inpatient, and death certificate data sets, probabilistic linkage provides a comprehensive description of snowmobile-related injuries and a baseline evaluation of morbidity, mortality, and financial burden.



• See also a report under Transportation

• Farm injury in Tasmania.

  Mather C, Lower T. Aust J Rural Health 2001; 9(5): 209-215.
  
  Correspondence: Carey A. Mather, Tasmanian General Practice Divisions, Tasmania and Combined Universities Centre for Rural Health, Curtin University, Geraldton, Western Australia, Australia. (E-mail: lowert@cucrh.uwa.edu.au).

  OBJECTIVES: The aim of the study was to provide information about the type and severity of farming injury.
  
  METHODS:Data were collected from industrial members of the Tasmanian Farmers and Graziers Association, using a valid and reliable self administered retrospective questionnaire covering the previous 2 years.
  
  RESULTS: A total of 506 responses were obtained, with 38% indicating there had been at least one injury sustained on their farm during this period. Of those reporting an injury, 18% were admitted, 30% attended an Emergency Department, 43% of injuries were seen by GPs at their surgery, 4% received first aid on the farm, 4% reported no treatment and 2% utilized another source. The results suggest that the sheep industries bear a disproportionate amount of the injury burden (30.5%) within Tasmanian agriculture.
  
  CONCLUSIONS: Information from this study can be used by other agricultural and health stakeholders to provide direction about the development of appropriate farm injury prevention strategies within rural communities in Tasmania.



• A YRBS survey of youth risk behaviors at alternative high schools and mainstream high schools in Hong Kong.

  Lee A, Tsang CK, Lee SH, To CT. J Sch Health 2001; 71(9): 443-447.
  
  Correspondence: A. Lee, Centre for Health Education and Health Promotion, School of Public Health, Chinese University of Hong Kong. alee@cuhk.edu.hk

  In Hong Kong, prevocational schools serve as an alternative to mainstream schools to provide education with more emphasis on practical and technical subjects. In this paper, health-risk behaviors of prevocational school (PVS) students were identified, and comparisons of health-risk behaviors with or without adjusting the demographic factors from prevocational schools and mainstream schools were made. The PVS students were at higher risk for most categories of health-risk behaviors such as unintentional and intentional injuries, smoking, alcohol drinking, glue sniffing, inadequate physical activity, insufficient consumption of fresh fruits and vegetables, and early sexual activity with multiple partners. Female students of PVS reported higher prevalence of emotional problems and substance abuse. Findings suggest that the school environment is an influential factor on the lifestyle behavior of students. Comprehensive health education and intervention programs are needed for youth in Hong Kong prevocational schools.

Suicide:

• No reports this week



• Motor Vehicle Crash Fatalities in the Elderly: Rural versus Urban.

  Clark DE. J Trauma 2001; 51(11): 896-900.
  
  Correspondence: David E. Clark, Department of Surgery, Maine Medical Center, 22 Bramhall Street Portland, Maine 04102-3175 (E-mail: clarkd@poa.mmc.org).

  BACKGROUND: The elderly contribute disproportionately to hospital trauma mortality and expense. This population and its traffic fatality rate are increasing.
  
  OBJECTIVES: The purpose of this study was to determine how the effect of age on vehicle-related mortality is modified by population density.
  
  METHODS: FARS data for vehicle drivers and passengers were analyzed after linkage to census age-specific county population and area estimates. Characteristics of crash fatalities in the elderly (65 years old) were compared with younger victims, for each quartile of county population density.
  
  RESULTS: There were 5905 fatalities among the elderly, and 26,159 among the younger population, yielding annual rates (per 100,000) of 17.6 and 11.4. Rates were higher in counties with lower population density, but always higher among the elderly. Elderly fatal crash victims in all county quartiles were less likely to be male, unrestrained, riding with an intoxicated driver, or traveling over 60 MPH; all these risk factors were more frequent at lower population densities, regardless of age. Fatal crashes at intersections were more likely in the elderly, especially at higher population densities.
  
  CONCLUSIONS: Older age and lower population density independently increase vehicle-related mortality. Differing characteristics in each category suggest different preventive strategies.

• Head injury mechanisms in helmet-protected motorcyclists: prospective multicenter study.

  Richter M, Otte D, Lehmann U, Chinn B, Schuller E, Doyle D, Sturrock K, Krettek C. J Trauma 2001 Nov;51(5):949-958.
  
  Correspondence: Martinus Richter, Trauma Department, Hannover Medical School Accident Research Unit, Hannover, Germany. (E-mail: richter.martinus@mh-hannover.de).

  OBJECTIVES: To investigate head injury mechanisms in helmet-protected motorcyclists.
  
  METHODS: In a prospective study, three research groups at Hannover (H) and Munich (M) in Germany and Glasgow (G) in the United Kingdom collected data from motorcycle crashes between July 1996 and July 1998. The head lesions of motorcyclists with Abbreviated Injury Score-Head (AISHead) 2+ injuries and/or helmet impact were classified into direct force effect (DFE) and indirect force effect (IFE) lesions. The effecting forces and the force consequences were analyzed in detail.
  
  RESULTS: Two-hundred twenty-six motorcyclists (H, n = 115; M, n = 56; and G, n = 55) were included. Collision opponents were cars (57.8%), trucks (8.0%), pedestrians (2.3%), bicycles (1.4%), two-wheel motor vehicles (0.8%), and others (4.2%). In 25.4% no other moving object was involved. The mean impact speed was 55 km/h (range, 0-120 km/h) and correlated with AISHead. Seventy-six (33%) motorcyclists had no head injury, 21% (n = 48) AISHead 1, and 46% (n = 103) AISHead 2+. Four hundred nine head lesions were further classified: 36.9% DFE and 63.1% IFE. Lesions included 20.5% bone, 51.3% brain, and 28.1% skin. The most frequent brain lesions were subdural hematomas (22.4%, n = 47) and subarachnoid hematomas (25.2%, n = 53). Lesions of skin or bone were mainly DFE lesions, whereas brain lesions were mostly IFE lesions.
  
  CONCLUSIONS: A modification of the design of the helmet shell may have a preventative effect on DFE lesions, which are caused by a high amount of direct force transfer. Acceleration or deceleration forces induce IFE lesions, particularly rotation, which is an important and underestimated factor. The reduction of the effecting forces and the kinetic consequences should be a goal for future motorcycle helmet generations.



• Female victims of intimate partner physical domestic violence (IPP-DV), California 1998.

  Weinbaum Z, Stratton TL, Chavez G, Motylewski-Link C, Barrera N, Joseph G. Courtney JG. Am J Prev Med 21(4): 313-319.
  
  Correspondence: : Zipora Weinbaum, PhD, California Department of Health Services, Maternal and Child Health Branch, Domestic Violence Section, 714 P Street, Room 540, Sacramento, CA 95814. (E-mail: zweinbau@dhs.ca.gov

  OBJECTIVES: This study was conducted to identify factors associated with adult female victims of intimate partner physical domestic violence (IPP-DV) in California and to estimate statewide IPP-DV prevalence.
  
  METHODS: We analyzed data from the 1998 California Women's Health Survey, a random, computer-assisted telephone interview (CATI) survey of 4006 California women aged 18, conducted by the California Department of Health Services.
  
  RESULTS: Data from the survey indicated that 6% of the women reported that in the previous 12 months, their intimate partners threw objects at them, or hit them with an object, or kicked, pushed, slapped, choked, beat up, or threatened them with a gun or a knife. Odds ratio (OR) analyses controlling for age and race/ethnicity suggest that a large number of factors are associated statistically with IPP-DV victims. These factors include feelings of ill physical and mental health; pregnancies at early age; smoking status; nutritional needs; low income; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program; having children aged <18 in the household; and limited access to health care. Among the non-U.S.-born respondents, IPP-DV victims were significantly younger when they entered the United States than their nonvictim counterparts. A multiple logistic regression model identified the following factors as main correlates with IPP-DV: feelings of being overwhelmed in the past 30 days (OR=3.4, 95% confidence interval [CI]=2.5–4.6); aged 18 to 44 (OR=2.8, 95% CI=1.9–4.1); current smoking status (OR=2.1, 95% CI=1.5–2.9); participation in WIC in the previous 2 years (OR=1.8, 95% CI=1.2–2.6); and being out of work (OR=1.4, 95% CI=1.1–1.9).
  
  CONCLUSIONS: The above findings suggest that a variety of venues (e.g., schools, mental and physical health care providers, WIC, immigration programs, and social services) will be needed in order to identify/gain access to IPP-DV victims, provide referral resources, and implement any future prevention efforts.

• Evaluation of Responding in Peaceful and Positive Ways (RIPP): a school-based prevention program for reducing violence among urban adolescents.

  Farrell AD, Meyer AL, White KS. J Clin Child Psychol 2001; 30(4):451-463.
  
  Correspondence: AD Farrell, Department of Psychology, P.O. Box 842018, Virginia Commonwealth University, Richmond, VA 23284-2018, USA. (E-mail: afarrell@vcu.edu).

  BACKGROUND: Violence among adolescents is a continuing problem. There are several programs to reduce violent behavior in this age group.
  
  OBJECTIVES: To evaluate Responding in Peaceful and Positive Ways (RIPP)--a 6th-grade universal violence prevention program.
  
  METHODS: Classes of 6th graders at 3 urban middle schools serving predominantly African American youth were randomized to intervention (N = 321) and control groups (N = 305).
  
  RESULTS: Intervention effects were found on a knowledge test but not on other mediating variables. RIPP participants had fewer disciplinary violations for violent offenses and in-school suspensions at posttest compared with the control group. The reduction in suspensions was maintained at 12-month follow-up for boys but not for girls. RIPP participants also reported more frequent use of peer mediation and reductions in fight-related injuries at posttest. Intervention effects on several measures approached significance at 6-month and 12-month follow-up. The program's impact on violent behavior was more evident among those with high pretest levels of problem behavior.

• Confronting barriers to universal screening for domestic violence.

  Davis RE, Harsh KE. J Prof Nurs 2001; 17(6): 313-320.
  
  Correspondence: Ruth E. Davis, Millersville University, P.O. Box 1002, Millersville, PA 17551, USA. Ruth.Davis@millersville.edu

  Nationally, domestic violence has reached epidemic proportions. Universal screening is a vital means to identify those women who suffer in abusive relationships with intimate partners. Collaborative efforts between a community shelter for abused women and a local medical center's emergency department resulted in the development and implementation of a universal screening process. Barriers encountered by the emergency department nursing staff during the initial phase of screening included lack of information about domestic violence issues as well as about the tool, personal perceptions and feelings about domestic violence, and institutional barriers such as lack of time, space, and privacy in the emergency department. Of these, informational and affective barriers of nursing staff are viewed as the most significant. Discussion includes a call for emphasis on domestic violence in the curricula of nursing programs and those of other health care providers and use of universal screening to identify and assist abused women. Interdisciplinary methods of formal education, in-service training, and continuing education are encouraged to augment existing universal screening, as well as to assist those who have yet to implement such a process.





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Rev. 16-Dec-2001 at 08:28 hours.